Individual
DR. JEREMY S REISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
14050 FRUIT RIDGE AVE, KENT CITY, MI 49330-8922
(616) 378-5538
(616) 399-4491
Mailing address
4310 LEONARD ST NW, SUITE 103, WALKER, MI 49534-8447
(616) 453-6329
(616) 453-1725
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301009144
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11553234
CAQH
MI
01
—
2301009144
LICENSE NUMBER
MI
05
—
4873635
—
MI
Enumeration date
01/23/2006
Last updated
04/27/2016
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